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124-710: This response is recognised as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms . Originally understood as the "fight-or-flight" response in Cannon's research, the state of hyperarousal results in several responses beyond fighting or fleeing. This has led people to calling it the "fight, flight, freeze" response, "fight-flight-freeze-fawn" or "fight-flight-faint-or-freeze", among other variants. The wider array of responses, such as freezing , flop, faint, flee and fright, has led researchers to use more neutral or accommodating terminology such as "hyperarousal" or

248-446: A major physical trauma or prolonged starvation can greatly disrupt homeostasis. On the other hand, an organism's attempt at restoring conditions back to or near homeostasis, often consuming energy and natural resources, can also be interpreted as stress. The brain cannot sustain an equilibrium under chronic stress; the accumulation of such an ever-deepening deficit is called chronic stress. The ambiguity in defining this phenomenon

372-519: A smallmouth bass (i.e. inspecting the predator, hiding, or swimming away) after which the guppies were left in a tank with the bass. After 60 hours, 40 percent of the timid guppies and 15 percent of the ordinary guppies survived while none of the bold guppies did. Animals respond to threats in many complex ways. Rats, for instance, try to escape when threatened but will fight when cornered. Some animals stand perfectly still so that predators will not see them. Many animals freeze or play dead when touched in

496-478: A brief biological background of neuroanatomy and neurochemistry and how they relate to stress. Stress, either severe, acute stress or chronic low-grade stress may induce abnormalities in three principal regulatory systems in the body: serotonin systems , catecholamine systems , and the hypothalamic-pituitary-adrenocortical axis . Aggressive behavior has also been associated with abnormalities in these systems. The brain endocrine interactions are relevant in

620-436: A brief separation can produce panic. Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety. Obsessive–compulsive disorder (OCD)

744-599: A conclusion. First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder, social anxiety disorder or panic disorder. For adults, there is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice. Fluvoxamine is effective in treating a range of anxiety disorders in children and adolescents. Fluoxetine , sertraline , and paroxetine can also help with some forms of anxiety in children and adolescents. If

868-436: A connection between the systems. The HPA axis ultimately results in the release of cortisol, which generally has immunosuppressive effects. However, the effect of stress on the immune system is disputed, and various models have been proposed in an attempt to account for both the supposedly "immunodeficiency" linked diseases and diseases involving hyper activation of the immune system. One model proposed to account for this suggests

992-408: A diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those with panic disorder experience symptoms even outside of specific panic episodes. Often, normal changes in heartbeat are noticed, leading them to think something

1116-452: A first line pharmacologic treatment of anxiety disorders and they carry risks of physical dependence , psychological dependence , overdose death (especially when combined with opioids), misuse, cognitive impairment , falls and motor vehicle crashes. Buspirone and pregabalin are second-line treatments for people who do not respond to SSRIs or SNRIs. Pregabalin and gabapentin are effective in treating some anxiety disorders, but there

1240-474: A given situation. The fight or flight actions also have polarity – the individual can either fight against or flee from something that is threatening, such as a hungry lion, or fight for or fly towards something that is needed, such as the safety of the shore from a raging river. A threat from another animal does not always result in immediate fight or flight. There may be a period of heightened awareness, during which each animal interprets behavioral signals from

1364-425: A group of mental and behavioral disorders which have their aetiology in reaction to severe stress and the consequent adaptive response. Chronic stress, and a lack of coping resources available, or used by an individual, can often lead to the development of psychological issues such as delusions , depression and anxiety (see below for further information). Chronic stress also causes brain atrophy , which

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1488-440: A model dividing stress into eustress and distress . Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress. Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behavior. The difference between experiences that result in eustress and those that result in distress

1612-416: A number of physical changes that have both short- and long-term effects on the body. The Holmes and Rahe stress scale was developed as a method of assessing the risk of disease from life changes. The scale lists both positive and negative changes that elicit stress. These include things such as a major holiday or marriage, or death of a spouse and firing from a job. Homeostasis is a concept central to

1736-491: A number of treatments that form the basis of the care plan for those with PTSD; such treatments include cognitive behavioral therapy (CBT), prolonged exposure therapy, stress inoculation therapy, medication, psychotherapy, and support from family and friends. Post-traumatic stress disorder research began with US military veterans of the Vietnam War, as well as natural and non-natural disaster victims. Studies have found

1860-1012: A panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home. Social anxiety disorder (SAD), also known as social phobia, describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or it can be experienced in most or all social situations. Roughly 7% of American adults have social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years. Social anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking. As with all phobic disorders, those with social anxiety often attempt to avoid

1984-684: A person with Alzheimer's disease. Chronic stress has also been shown to impair developmental growth in children by lowering the pituitary gland 's production of growth hormone, as in children associated with a home environment involving serious marital discord, alcoholism , or child abuse . Chronic stress also has a lot of illnesses and health care problems other than mental that comes with it. Severe chronic stress for long periods of time can lead to an increased chance of catching illnesses such as diabetes, cancer, depression, heart disease and Alzheimer's disease. More generally, prenatal life, infancy, childhood, and adolescence are critical periods in which

2108-467: A person with effective coping mechanisms for dealing with psychological stress , with stress defined as a person's physiological response to an internal or external stimulus that triggers the fight-or-flight response. Stress management is effective when a person uses strategies to cope with or alter stressful situations. There are several ways of coping with stress, such as controlling the source of stress or learning to set limits and to say "no" to some of

2232-730: A person's ability to function in daily life. Symptoms may include: feeling nervous, anxious, or on edge; worrying excessively; difficulty concentrating; restlessness; and irritability. Questionnaires developed for clinical use include the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale , and

2356-425: A person's other medical conditions, and medications. Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first-line treatment. CBT is the most widely studied and preferred form of psychotherapy for anxiety disorders. CBT appears to be equally effective when carried out via the internet compared to sessions completed face-to-face. There are specific CBT cirriculums or strategies for

2480-472: A place or situation where escape is difficult or embarrassing or where help may be unavailable. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that individuals often develop. For example, following

2604-494: A preference for habit based learning , and decreased task flexibility and spatial working memory , probably through alterations of the dopaminergic systems . Stress may also increase reward associated with food, leading to weight gain and further changes in eating habits. Stress may contribute to various disorders, such as fibromyalgia , chronic fatigue syndrome , depression , as well as other mental illnesses and functional somatic syndromes . Selye published in year 1975

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2728-402: A psychosocial situation to be stressful, it must be appraised as such. He argued that cognitive processes of appraisal are central in determining whether a situation is potentially threatening, constitutes a harm/loss or a challenge, or is benign. Both personal and environmental factors influence this primary appraisal, which then triggers the selection of coping processes. Problem-focused coping

2852-495: A push towards an imbalance of cellular immunity (Th1) and humoral immunity (Th2). The proposed imbalance involved hyperactivity of the Th2 system leading to some forms of immune hypersensitivity , while also increasing risk of some illnesses associated with decreased immune system function, such as infection and cancer . Chronic stress is a term sometimes used to differentiate it from acute stress. Definitions differ, and may be along

2976-451: A recognized external threat. The umbrella term 'anxiety disorder' refers to a number of specific disorders that include fears (phobias) and/or anxiety symptoms. There are several types of anxiety disorders, including generalized anxiety disorder , hypochondriasis , specific phobia , social anxiety disorder , separation anxiety disorder , agoraphobia , panic disorder , and selective mutism . Individual disorders can be diagnosed using

3100-485: A relapse of symptoms. Exposure and response prevention (ERP) has been found effective for treating PTSD, phobias, OCD and GAD. Mindfulness -based programs also appear to be effective for managing anxiety disorders. It is unclear if meditation has an effect on anxiety, and transcendental meditation appears to be no different from other types of meditation. A 2015 Cochrane review of Morita therapy for anxiety disorder in adults found not enough evidence to draw

3224-400: A role in hypertension , and may further predispose people to other conditions associated with hypertension. Stress may precipitate abuse of drugs and/or alcohol. Stress may also contribute to aging and chronic diseases in aging, such as depression and metabolic disorders. The immune system also plays a role in stress and the early stages of wound healing . It is responsible for preparing

3348-510: A serious accident. It can also result from long-term (chronic) exposure to a severe stressor— for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance , flashbacks , avoidant behaviors, anxiety, anger, and depression. In addition, individuals may experience sleep disturbances. People who have PTSD often try to detach themselves from their friends and family and have difficulty maintaining these close relationships. There are

3472-401: A shift from Th1 (cellular) to Th2 (humoral) immunity, while decreased T-cell proliferation, and natural killer cell cytotoxicity. Stressful event sequences did not elicit a consistent immune response; however, some observations such as decreased T-Cell proliferation and cytotoxicity, increase or decrease in natural killer cell cytotoxicity, and an increase in mitogen PHA. Chronic stress elicited

3596-441: A shift toward Th2 immunity, as well as decreased interleukin 2, T cell proliferation, and antibody response to the influenza vaccine . Distant stressors did not consistently elicit a change in immune function. Another response to high impacts of chronic stress that lasts for a long period of time, is more immune dysfunction and more metabolic dysfunction. It is proven in studies that when continuously being in stressful situations, it

3720-474: A spouse with dementia, or may result from brief focal events that have long term effects, such as experiencing a sexual assault. Studies have also shown that psychological stress may directly contribute to the disproportionately high rates of coronary heart disease morbidity and mortality and its etiologic risk factors . Specifically, acute and chronic stress have been shown to raise serum lipids and are associated with clinical coronary events. However, it

3844-451: A state similar to hyperaldosteronism . If the stressor persists, it becomes necessary to attempt some means of coping with the stress. The body attempts to respond to stressful stimuli, but after prolonged activation, the body's chemical resources will be gradually depleted, leading to the final stage. The third stage could be either exhaustion or recovery : The result can manifest itself in obvious illnesses, such as general trouble with

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3968-401: A stranger's hand, and then held no one's hand. When the women were holding their husband's hand, the response was reduced in many brain areas. When holding the stranger's hand the response was reduced a little, but not as much as when they were holding their husband's hand. Social support helps reduce stress and even more so if the support is from a loved one. Lazarus argued that, in order for

4092-499: A therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment. Globally, as of 2010, approximately 273 million (4.5% of the population) had an anxiety disorder. It is more common in females (5.2%) than males (2.8%). In Europe, Africa, and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%. In

4216-554: A variety of factors that determine behavior in the context of social situations and preexisting thoughts. The attribution of hostility, especially in ambiguous situations, seems to be one of the most important cognitive factors associated with the fight or flight response because of its implications towards aggression. An evolutionary psychology explanation is that early animals had to react to threatening stimuli quickly and did not have time to psychologically and physically prepare themselves. The fight or flight response provided them with

4340-448: A variety of other symptoms that may vary based on the individual. In casual discourse, the words anxiety and fear are often used interchangeably. In clinical usage, they have distinct meanings; anxiety is clinically defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is clinically defined as an emotional and physiological response to

4464-483: A whole with the influence of mass media. The intermediate level includes healthcare professionals and their perspectives. The micro-level details the individual's contributions to the process through self-stigmatization. Stigma can be described in three conceptual ways: cognitive, emotional, and behavioral. This allows for differentiation between stereotypes, prejudice, and discrimination. Treatment options include psychotherapy , medications and lifestyle changes. There

4588-435: Is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance". Generalized anxiety disorder is the most common anxiety disorder to affect older adults. Anxiety can be a symptom of a medical or substance use disorder problem, and medical professionals must be aware of this. A diagnosis of GAD

4712-443: Is a common issue in self-defense criminal cases. Expert opinions are usually required if the defender's fault becomes the focus of the case. Stress (biology)#General adaptation syndrome Stress , whether physiological , biological or psychological , is an organism's response to a stressor such as an environmental condition. When stressed by stimuli that alter an organism's environment, multiple systems respond across

4836-445: Is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety . People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or even punishment. Selective mutism affects about 0.8% of people at some point in their lives. Testing for selective mutism

4960-676: Is a sub-type of social anxiety involving concern over the evaluation of one's body by others. SPA is common among adolescents, especially females. Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in the DSM-V) that results from a traumatic experience. PTSD affects approximately 3.5% of U.S. adults every year, and an estimated one in eleven people will be diagnosed with PTSD in their lifetime. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even

5084-424: Is absent from both lay and expert life narratives before the 1930s". Physiological stress represents a wide range of physical responses that occur as a direct effect of a stressor causing an upset in the homeostasis of the body. Upon immediate disruption of either psychological or physical equilibrium the body responds by stimulating the nervous , endocrine , and immune systems . The reaction of these systems causes

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5208-400: Is characterized by three phases: a nonspecific alarm mobilization phase, which promotes sympathetic nervous system activity; a resistance phase, during which the organism makes efforts to cope with the threat; and an exhaustion phase, which occurs if the organism fails to overcome the threat and depletes its physiological resources. Alarm is the first stage, which is divided into two phases:

5332-612: Is concern regarding their off-label use due to the lack of strong scientific evidence for their efficacy in multiple conditions and their proven side effects. Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions. In general, medications are not seen as helpful for specific phobias , but benzodiazepines are sometimes used to help resolve acute episodes. In 2007, data were sparse for

5456-536: Is determined by the disparity between an experience (real or imagined) and personal expectations, and resources to cope with the stress. Alarming experiences, either real or imagined, can trigger a stress response. Responses to stress include adaptation, psychological coping such as stress management , anxiety, and depression . Over the long term, distress can lead to diminished health and/or increased propensity to illness; to avoid this, stress must be managed. Stress management encompasses techniques intended to equip

5580-465: Is directed at managing the problem, whereas emotion-focused coping processes are directed at managing the negative emotions. Secondary appraisal refers to the evaluation of the resources available to cope with the problem, and may alter the primary appraisal. In other words, primary appraisal includes the perception of how stressful the problem is and the secondary appraisal of estimating whether one has more than or less than adequate resources to deal with

5704-411: Is important because doctors must determine if it is an issue associated with the child's hearing or movements associated with the jaw or tongue and if the child can understand when others are speaking to them. Generally, cognitive behavioral therapy (CBT) is the recommended approach for treating selective mutism, but prospective long-term outcome studies are lacking. The diagnosis of anxiety disorders

5828-448: Is increasing on the prevention of anxiety disorders. There is tentative evidence to support the use of cognitive behavioral therapy and mindfulness therapy. A 2013 review found no effective measures to prevent GAD in adults. A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety. Research indicates that predictors of the emergence of anxiety disorders partly differ from

5952-1149: Is intended as a general guide with allowance for some degree of flexibility and is sometimes of shorter duration in children. The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause. Diseases that may present similar to an anxiety disorder include certain endocrine diseases ( hypo- and hyperthyroidism , hyperprolactinemia ), metabolic disorders ( diabetes ), deficiency states (low levels of vitamin D , B2 , B12 , folic acid ), gastrointestinal diseases ( celiac disease , non-celiac gluten sensitivity , inflammatory bowel disease ), heart diseases, blood diseases ( anemia ), and brain degenerative diseases ( Parkinson's disease , dementia , multiple sclerosis , Huntington's disease ). Several drugs can also cause or worsen anxiety, whether through intoxication, withdrawal, or chronic use. These include alcohol , tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription painkillers and illicit drugs like heroin), stimulants (such as caffeine, cocaine, and amphetamines), hallucinogens , and inhalants . Focus

6076-532: Is little evidence for the use of cannabis in treating anxiety disorders. Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders. Therapy is generally preferred to medication. Cognitive behavioral therapy (CBT) is a good first-line therapy approach. Studies have gathered substantial evidence for treatments that are not CBT-based as effective forms of treatment, expanding treatment options for those who do not respond to CBT. Although studies have demonstrated

6200-622: Is made by symptoms, triggers, and a person's personal and family histories. There are no objective biomarkers or laboratory tests that can diagnose anxiety. It is important for a medical professional to evaluate a person for other medical and mental causes of prolonged anxiety because treatments will vary considerably. Numerous questionnaires have been developed for clinical use and can be used for an objective scoring system. Symptoms may vary between each sub-type of generalized anxiety disorder. Generally, symptoms must be present for at least six months, occur more days than not, and significantly impair

6324-416: Is made when a person has been excessively worried about an everyday problem for six months or more. These stresses can include family life, work, social life, or their own health. A person may find that they have problems making daily decisions and remembering commitments as a result of a lack of concentration and/or preoccupation with worry. A symptom can be a strained appearance, with increased sweating from

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6448-650: Is more likely to get sick. Also, when being exposed to stress, some claim that the body metabolizes the food in a certain way that adds extra calories to the meal, regardless of the nutritional values of the food. Some studies have observed increased risk of upper respiratory tract infection during chronic life stress. In patients with HIV, increased life stress and cortisol was associated with poorer progression of HIV. Also with an increased level of stress, studies have proven evidence that it can reactivate latent herpes viruses. A link has been suggested between chronic stress and cardiovascular disease. Stress appears to play

6572-412: Is no clear evidence as to whether psychotherapy or medication is more effective; the specific medication decision can be made by a doctor and patient with consideration for the patient's specific circumstances and symptoms. If, while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered. Specific treatments will vary by sub-type of anxiety disorder,

6696-758: Is not an anxiety disorder in the DSM-5 or the ICD-11 . However, it was classified as such in older versions of the DSM-IV and ICD-10 . OCD manifests in the form of obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals) that are not caused by drugs or physical disorders and which cause anxiety or distress plus (more or less important) functional disabilities. OCD affects roughly 1–2% of adults (somewhat more women than men) and under 3% of children and adolescents. A person with OCD knows that

6820-551: Is not proportional to the actual potential danger, but they can still become overwhelmed by it. With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, or difficulty breathing. These panic attacks are defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes but can last for several hours. Attacks can be triggered by stress, irrational thoughts, general fear, fear of

6944-472: Is of a cat about to be attacked by a dog. The cat shows accelerated heartbeat, piloerection (hair standing on end), and pupil dilation, all signs of sympathetic arousal. Note that the zebra and cat still maintain homeostasis in all states. In July 1992, Behavioral Ecology published experimental research conducted by biologist Lee A. Dugatkin where guppies were sorted into "bold", "ordinary", and "timid" groups based upon their reactions when confronted by

7068-470: Is particularly pertinent to mental illnesses, whereby chronic or severe stress remains a common risk factor for several mental illnesses . Acute stressful situations where the stress experienced is severe is a cause of change psychologically to the detriment of the well-being of the individual, such that symptomatic derealization and depersonalization , and anxiety and hyperarousal , are experienced. The International Classification of Diseases includes

7192-536: Is possible for individuals to exhibit hardiness —a term referring to the ability to be both chronically stressed and healthy. Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain disease-free after being confronted with chronic stressful events. This suggests that there are individual differences in vulnerability to the potential pathogenic effects of stress; individual differences in vulnerability arise due to both genetic and psychological factors. In addition,

7316-455: Is seen in 20-70% of those with social anxiety disorder, 50% of those with panic disorder and 43% of those with general anxiety disorder. The 12 month prevalence of alcohol or substance use disorders in those with anxiety disorders is 16.5%. Worldwide, anxiety disorders are the second most common type of mental disorders after depressive disorders. Anxiety disorders affect nearly 30% of adults at some point in their lives, with an estimated 4% of

7440-491: Is that of specific phobias, which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide has specific phobias. According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations. Individuals with a phobia typically anticipate terrifying consequences from encountering

7564-418: Is the loss of neurons and the connections between them. It affects the part of the brain that is important for learning, responding to the stressors and cognitive flexibility. Chronic stressors may not be as intense as acute stressors such as natural disaster or a major accident, but persist over longer periods of time and tend to have a more negative effect on health because they are sustained and thus require

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7688-478: Is turned off a specific number of times before leaving the house. It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved. Risk factors include family history, being single, being of a higher socioeconomic class, or not being in paid employment. Of those with OCD, about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%). Selective mutism (SM)

7812-417: Is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others. In play therapy, the child is allowed to play however they please as

7936-400: Is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness ( hypervigilance ) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis ). Agoraphobia is a specific anxiety disorder wherein an individual is afraid of being in

8060-914: The Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30). The GAD-7 has a sensitivity of 57-94% and a specificity of 82-88% in the diagnosis of general anxiety disorder. All screening questionnaires, if positive, should be followed by clinical interview including assessment of impairment and distress, avoidance behaviors, symptom history and persistence to definitively diagnose an anxiety disorder. Some organizations support routinely screening all adults for anxiety disorders, with

8184-934: The Taylor Manifest Anxiety Scale . Other questionnaires combine anxiety and depression measurements, such as the Hamilton Anxiety Rating Scale , the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS). Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS),

8308-413: The adrenal gland releases, although this can increase storage of flashbulb memories it decreases long-term potentiation (LTP). The hippocampus is important in the brain for storing certain kinds of memories and damage to the hippocampus can cause trouble in storing new memories but old memories, memories stored before the damage, are not lost. Also high cortisol levels can be tied to the deterioration of

8432-657: The digestive system (e.g. occult bleeding , melena , constipation /obstipation), diabetes , or even cardiovascular problems ( angina pectoris ), along with clinical depression and other mental illnesses. Anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and

8556-652: The parasympathetic nervous system returns the body to homeostasis . The second major physiological stress-response center, the HPA axis, regulates the release of cortisol , which influences many bodily functions such as metabolic, psychological and immunological functions . The SAM and HPA axes are regulated by several brain regions, including the limbic system , prefrontal cortex , amygdala , hypothalamus , and stria terminalis . Through these mechanisms, stress can alter memory functions , reward , immune function , metabolism and susceptibility to diseases. Disease risk

8680-407: The shock phase and the antishock phase. Resistance is the second stage. During this stage, increased secretion of glucocorticoids intensifies the body's systemic response. Glucocorticoids can increase the concentration of glucose, fat, and amino acid in blood. In high doses, one glucocorticoid, cortisol , begins to act similarly to a mineralocorticoid ( aldosterone ) and brings the body to

8804-411: The spinal cord and its main function is to activate the arousal responses that occur during the fight-or-flight response. The sympathetic nervous system transfers signals from the dorsal hypothalamus, which activates the heart, increases vascular resistance, and increases blood flow, especially to the muscle, heart, and brain tissues. It activates the adrenal medulla, releasing catecholamines that amplify

8928-481: The "acute stress response". The autonomic nervous system is a control system that acts largely unconsciously and regulates heart rate , digestion , respiratory rate , pupillary response , urination , and sexual arousal . This system is the primary mechanism in control of the fight-or-flight response and its role is mediated by two different components: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system originates in

9052-505: The US Preventative Services Task Force recommending screening for all adults younger than 65. Anxiety disorders differ from developmentally normal fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration

9176-607: The age at which the stress is experienced can dictate its effect on health. Research suggests chronic stress at a young age can have lifelong effects on the biological, psychological, and behavioral responses to stress later in life. The term "stress" had none of its contemporary connotations before the 1920s. It is a form of the Middle English destresse , derived via Old French from the Latin stringere , "to draw tight". The word had long been in use in physics to refer to

9300-433: The autonomic nervous system. While the sympathetic nervous system is activated, the parasympathetic nervous system decreases its response. Efferent vagal fibers originating from the nucleus ambiguous fire in parallel to the respiratory system, decreasing the vagal cardiac parasympathetic tone. After the fight or flight response, the parasympathetic system's main function is to activate the "rest and digest" response and return

9424-416: The body increased strength and speed in anticipation of fighting or running. Some of the specific physiological changes and their functions include: In the context of the fight or flight response, emotional regulation is used proactively to avoid threats of stress or to control the level of emotional arousal. During the reaction, the intensity of emotion that is brought on by the stimulus will also determine

9548-425: The body to homeostasis . This system utilizes and activates the release of the neurotransmitter acetylcholine . The reaction begins in the amygdala , which triggers a neural response in the hypothalamus . The initial reaction is followed by activation of the pituitary gland and secretion of the hormone ACTH . The adrenal gland is activated almost simultaneously, via the sympathetic nervous system, and releases

9672-728: The body's physiological response to occur daily. This depletes the body's energy more quickly and usually occurs over long periods of time, especially when these microstressors cannot be avoided (i.e. stress of living in a dangerous neighborhood). See allostatic load for further discussion of the biological process by which chronic stress may affect the body. For example, studies have found that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse physical health than non-caregivers. When humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses may occur. Chronic stress can include events such as caring for

9796-476: The body's response to a stressor or embody the act of stress itself is part of the ambiguity in defining what exactly stress is. The central nervous system works closely with the body's endocrine system to regulate these mechanisms. The sympathetic nervous system becomes primarily active during a stress response , regulating many of the body's physiological functions in ways that ought to make an organism more adaptive to its environment. Below there follows

9920-498: The body. In humans and most mammals, the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis are the two major systems that respond to stress. Two well-known hormones that humans produce during stressful situations are adrenaline and cortisol . The sympathoadrenal medullary (SAM) axis may activate the fight-or-flight response through the sympathetic nervous system , which dedicates energy to more relevant bodily systems to acute adaptation to stress, while

10044-408: The brain stem nuclei, particularly the noradrenergic nuclei stimulate CRH release. Other regions of the hypothalamus both directly and indirectly inhibit HPA axis activity. Hypothalamic neurons involved in regulating energy balance also influence HPA axis activity through the release of neurotransmitters such as neuropeptide Y , which stimulates HPA axis activity. Generally, the amygdala stimulates, and

10168-464: The broader context of cognitive-consistency theory . Stress can have many profound effects on the human biological systems. Biology primarily attempts to explain major concepts of stress using a stimulus-response paradigm, broadly comparable to how a psychobiological sensory system operates. The central nervous system (brain and spinal cord) plays a crucial role in the body's stress-related mechanisms. Whether one should interpret these mechanisms as

10292-609: The chosen medicine is effective, it is recommended that it be continued for at least a year to potentiate the risk of a relapse. Benzodiazepines are a second line option for the pharmacologic treatment of anxiety. Benzodiazepines are associated with moderate to high effect sizes with regard to symptom relief and they have an onset usually within 1 week. Clonazepam has a longer half life and may possibly be used as once per day dosing. Benzodiazepines may also be used with SNRIs or SSRIs to initially reduce anxiety symptoms, and they may potentially be continued long term. Benzodiazepines are not

10416-446: The circulation of cortisol functions to turn fatty acids into available energy, which prepares muscles throughout the body for response. Catecholamine hormones, such as adrenaline ( epinephrine ) or noradrenaline (norepinephrine), facilitate immediate physical reactions associated with a preparation for violent muscular action. The physiological changes that occur during the fight or flight response are activated in order to give

10540-539: The degree of exposure to a disaster to be the best predictor of PTSD. Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder. Separation anxiety disorder affects roughly 7% of adults and 4% of children, but childhood cases tend to be more severe; in some instances, even

10664-450: The demands that bosses or family members may make. A person's capacity to tolerate the source of stress may be increased by thinking about another topic such as a hobby, listening to music, or spending time in a wilderness . A way to control stress is first dealing with what is causing the stress if it is something the individual has control over. Other methods to control stress and reduce it can be: to not procrastinate and leave tasks for

10788-425: The digestive system, secretion of the epinephrine and cortisol from the adrenal medulla, and relaxation of the bladder wall. The parasympathetic nervous response, "rest and digest", involves return to maintaining homeostasis, and involves miosis , bronchoconstriction , increased activity of the digestive system, and contraction of the bladder walls. Complex relationships between protective and vulnerability factors on

10912-474: The effect of childhood home stress on psychological illness, cardiovascular illness and adaption have been observed. ANS related mechanisms are thought to contribute to increased risk of cardiovascular disease after major stressful events. The HPA axis is a neuroendocrine system that mediates a stress response. Neurons in the hypothalamus, particularly the paraventricular nucleus , release vasopressin and corticotropin releasing hormone , which travel through

11036-487: The effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than treatment as usual , medication, or wait list controls is inconclusive. Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings. Each family member may attend individual therapy, but family therapy

11160-828: The effects that acute stressors have on the immune system may be increased when there is perceived stress and/or anxiety due to other events. For example, students who are taking exams show weaker immune responses if they also report stress due to daily hassles. While responses to acute stressors typically do not impose a health burden on young, healthy individuals, chronic stress in older or unhealthy individuals may have long-term effects that are detrimental to health. Acute time-limited stressors, or stressors that lasted less than two hours, results in an up regulation of natural immunity and down regulation of specific immunity . This type of stress saw in increase in granulocytes , natural killer cells , IgA , Interleukin 6 , and an increase in cell cytotoxicity. Brief naturalistic stressors elicit

11284-549: The efficacy of any drug. Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking. Stopping smoking has benefits for anxiety as great as or greater than those of medications. A meta-analysis found 2000 mg/day or more of omega-3 polyunsaturated fatty acids, such as fish oil, tended to reduce anxiety in placebo-controlled and uncontrolled studies, particularly in people with more significant symptoms. As of 2019 , there

11408-583: The factors that predict their persistence. People with an anxiety disorder may be challenged by prejudices and stereotypes held by other people, most likely as a result of misconceptions around anxiety and anxiety disorders. Misconceptions found in a data analysis from the National Survey of Mental Health Literacy and Stigma include: (1) many people believe anxiety is not a real medical illness; and (2) many people believe that people with anxiety could turn it off if they wanted to. For people experiencing

11532-562: The global population currently experiencing an anxiety disorder. However, anxiety disorders are treatable, and a number of effective treatments are available. Most people are able to lead normal, productive lives with some form of treatment. Generalized anxiety disorder (GAD) is a common disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those with generalized anxiety disorder experience non-specific persistent fear and worry and become overly concerned with everyday matters. Generalized anxiety disorder

11656-415: The hands, feet, and axillae, along with tearfulness, which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes. In children, GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations. Typically, it begins around eight to nine years of age. The largest category of anxiety disorders

11780-407: The hippocampus and decline of memory that many older adults start to experience with age. These mechanisms and processes may therefore contribute to age-related disease, or originate risk for earlier-onset disorders. For instance, extreme stress (e.g. trauma) is a requisite factor to produce stress-related disorders such as post-traumatic stress disorder. Chronic stress also shifts learning, forming

11904-539: The hope that the predator will lose interest. Other animals have alternative self-protection methods. Some species of cold-blooded animals change color swiftly to camouflage themselves. These responses are triggered by the sympathetic nervous system , but, in order to fit the model of fight or flight, the idea of flight must be broadened to include escaping capture either in a physical or sensory way. Thus, flight can be disappearing to another location or just disappearing in place, and fight and flight are often combined in

12028-435: The hormone epinephrine . The release of chemical messengers results in the production of the hormone cortisol , which increases blood pressure , blood sugar , and suppresses the immune system . The initial response and subsequent reactions are triggered in an effort to create a boost of energy. This boost of energy is activated by epinephrine binding to liver cells and the subsequent production of glucose . Additionally,

12152-469: The hypophysial portal vessel where they travel to and bind to the corticotropin-releasing hormone receptor on the anterior pituitary gland . Multiple CRH peptides have been identified, and receptors have been identified on multiple areas of the brain, including the amygdala. CRH is the main regulatory molecule of the release of ACTH. The secretion of ACTH into systemic circulation allows it to bind to and activate Melanocortin receptor , where it stimulates

12276-567: The idea of stress. In biology , most biochemical processes strive to maintain equilibrium (homeostasis), a steady state that exists more as an ideal and less as an achievable condition. Environmental factors, internal or external stimuli, continually disrupt homeostasis; an organism's present condition is a state of constant flux moving about a homeostatic point that is that organism's optimal condition for living. Factors causing an organism's condition to diverge too far from homeostasis can be experienced as stress. A life-threatening situation such as

12400-562: The internal distribution of a force exerted on a material body, resulting in strain . In the 1920s and '30s, biological and psychological circles occasionally used "stress" to refer to a physiological or environmental perturbation that could cause physiological and mental "strain". The amount of strain in reaction to stress depends on the resilience . Excessive strain would appear as illness. Walter Cannon used it in 1926 to refer to external factors that disrupted what he called homeostasis . But "...stress as an explanation of lived experience

12524-460: The last minute, do things you like, exercise, do breathing routines, go out with friends, and take a break. Having support from a loved one also helps a lot in reducing stress. One study showed that the power of having support from a loved one, or just having social support, lowered stress in individual subjects. Painful shocks were applied to married women's ankles. In some trials women were able to hold their husband's hand, in other trials they held

12648-427: The lines of continual activation of the stress response, stress that causes an allostatic shift in bodily functions, or just as "prolonged stress". For example, results of one study demonstrated that individuals who reported relationship conflict lasting one month or longer have a greater risk of developing illness and show slower wound healing. It can also reduce the benefits of receiving common vaccines. Similarly,

12772-441: The mechanisms to rapidly respond to threats against survival. A typical example of the stress response is a grazing zebra . If the zebra sees a lion closing in for the kill, the stress response is activated as a means to escape its predator . The escape requires intense muscular effort, supported by all of the body's systems. The sympathetic nervous system 's activation provides for these needs. A similar example involving fight

12896-715: The natural regulatory capacity of an organism". The brain cannot live in an harsh family environment, it needs some sort of stability between another brain. People who have reported being raised in harsh environments such as verbal and physical aggression have showed a more immune dysfunction and more metabolic dysfunction. Indeed, in 1995 Toates already defined stress as a "chronic state that arises only when defense mechanisms are either being chronically stretched or are actually failing," while according to Ursin (1988) stress results from an inconsistency between expected events ("set value") and perceived events ("actual value") that cannot be resolved satisfactorily, which also puts stress into

13020-468: The nature and intensity of the behavioral response. Individuals with higher levels of emotional reactivity (Such as an anxiety disorder ) may be prone to anxiety and aggression , which illustrates the implications of appropriate emotional reaction in the fight or flight response. The specific components of cognitions in the fight or flight response seem to be largely negative. These negative cognitions may be characterised by: attention to negative stimuli,

13144-457: The object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat. People with specific phobias often go to extreme lengths to avoid encountering their phobia. People with specific phobias understand that their fear

13268-431: The other. Signs such as paling, piloerection, immobility, sounds, and body language communicate the status and intentions of each animal. There may be a sort of negotiation, after which fight or flight may ensue, but which might also result in playing, mating, or nothing at all. An example of this is kittens playing: each kitten shows the signs of sympathetic arousal, but they never inflict real damage. Acute stress response

13392-610: The perception of ambiguous situations as negative, and the recurrence of recalling negative words. There also may be specific negative thoughts associated with emotions commonly seen in the reaction. Perceived control relates to an individual's thoughts about control over situations and events. Perceived control should be differentiated from actual control because an individual's beliefs about their abilities may not reflect their actual abilities. Therefore, overestimation or underestimation of perceived control can lead to anxiety and aggression. The social information processing model proposes

13516-418: The person with it (Arnold. E and Boggs. K. 2007). Some common categories and examples of stressors include: Physiologists define stress as how the body reacts to a stressor - a stimulus, real or imagined. Acute stressors affect an organism in the short term; chronic stressors over the longer term. The general adaptation syndrome (GAS), developed by Hans Selye, is a profile of how organisms respond to stress; GAS

13640-445: The physical and mental symptoms of an anxiety disorder, stigma and negative social perception can make an individual less likely to seek treatment. Prejudice that some people with mental illness turn against themselves is called self-stigma. There is no explicit evidence for the exact cause of stigma towards anxiety. Stigma can be divided by social scale, into the macro, intermediate, and micro levels. The macro-level marks society as

13764-601: The postganglionic nerves, which is controlled by preganglionic neurons originating in the intermediolateral cell column . The ANS receives inputs from the medulla , hypothalamus , limbic system , prefrontal cortex , midbrain and monoamine nuclei . The activity of the sympathetic nervous system drives what is called the "fight or flight" response. The fight or flight response to emergency or stress involves mydriasis , increased heart rate and force contraction, vasoconstriction , bronchodilation , glycogenolysis , gluconeogenesis , lipolysis , sweating , decreased motility of

13888-496: The prefrontal cortex and hippocampus attenuate, HPA axis activity; however, complex relationships do exist between the regions. The immune system may be heavily influenced by stress. The sympathetic nervous system innervates various immunological structures, such as bone marrow and the spleen , allowing for it to regulate immune function. The adrenergic substances released by the sympathetic nervous system can also bind to and influence various immunological cells, further providing

14012-439: The problem that affects the overall appraisal of stressfulness. Further, coping is flexible in that, in general, the individual examines the effectiveness of the coping on the situation; if it is not having the desired effect, they will, in general, try different strategies. Both negative and positive stressors can lead to stress. The intensity and duration of stress changes depending on the circumstances and emotional condition of

14136-460: The release of steroid hormones . Steroid hormones bind to glucocorticoid receptors in the brain, providing negative feedback by reducing ACTH release. Some evidence supports a second long term feedback that is non-sensitive to cortisol secretion. The PVN of the hypothalamus receives inputs from the nucleus of the solitary tract , and lamina terminalis . Through these inputs, it receives and can respond to changes in blood. The PVN innervation from

14260-485: The source of their anxiety; in the case of social anxiety, this is particularly problematic, and in severe cases, it can lead to complete social isolation. Children are also affected by social anxiety disorder, although their associated symptoms are different from those of teenagers and adults. They may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation. Social physique anxiety (SPA)

14384-537: The specific and unique symptoms, triggering events, and timing. A medical professional must evaluate a person before diagnosing them with an anxiety disorder to ensure that their anxiety cannot be attributed to another medical illness or mental disorder. It is possible for an individual to have more than one anxiety disorder during their life or to have more than one anxiety disorder at the same time. Comorbid mental disorders or substance use disorders are common in those with anxiety. Comorbid depression (lifetime prevalence)

14508-487: The specific type of anxiety disorder. CBT has similar effectiveness to pharmacotherapy and in a meta analysis, CBT was associated with medium to large benefit effect sizes for GAD, panic disorder and social anxiety disorder. CBT has low dropout rates and its positive effects have been shown to be maintained at least for 12 months. CBT is sometimes given as once weekly sessions for 8–20 weeks, but regimens vary widely. Booster sessions may need to be restarted for patients who have

14632-412: The sympathetic response. Additionally, this component of the autonomic nervous system utilizes and activates the release of norepinephrine by the adrenal glands in the reaction. The parasympathetic nervous system originates in the sacral spinal cord and medulla , physically surrounding the sympathetic origin, and works in concert with the sympathetic nervous system. It is known as the calming portion of

14756-404: The symptoms are unreasonable and struggles against both the thoughts and the behavior. Their symptoms could be related to external events they fear, such as their home burning down because they forgot to turn off the stove, or they could worry that they will behave inappropriately. The compulsive rituals are personal rules they follow to relieve discomfort, such as needing to verify that the stove

14880-410: The tissue for repair and promoting recruitment of certain cells to the wound area. Consistent with the fact that stress alters the production of cytokines, Graham et al. found that chronic stress associated with care giving for a person with Alzheimer's disease leads to delayed wound healing. Results indicated that biopsy wounds healed 25% more slowly in the chronically stressed group, or those caring for

15004-532: The translation of stress into physiological and psychological changes. The autonomic nervous system (ANS), as mentioned above, plays an important role in translating stress into a response. The ANS responds reflexively to both physical stressors (for example baroreception ), and to higher level inputs from the brain. The ANS is composed of the parasympathetic nervous system and sympathetic nervous system , two branches that are both tonically active with opposing activities. The ANS directly innervates tissue through

15128-418: The unknown, or even when engaging in exercise. However, sometimes the trigger is unclear, and attacks can arise without warning. To help prevent an attack, one can avoid the trigger. This can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. This being said, not all attacks can be prevented. In addition to recurrent and unexpected panic attacks,

15252-451: The vulnerability to stressors is particularly high. This can lead to psychiatric and physical diseases which have long term impacts on an individual. Chronic stress is seen to affect the parts of the brain where memories are processed through and stored. When people feel stressed, stress hormones get over-secreted, which affects the brain. This secretion is made up of glucocorticoids , including cortisol, which are steroid hormones that

15376-576: Was first recognized by Hans Selye (1907–1982) in 1926. In 1951 a commentator loosely summarized Selye's view of stress as something that "...in addition to being itself, was also the cause of itself, and the result of itself". First to use the term in a biological context, Selye continued to define stress as "the non-specific response of the body to any demand placed upon it". Neuroscientists such as Bruce McEwen and Jaap Koolhaas believe that stress, based on years of empirical research, "should be restricted to conditions where an environmental demand exceeds

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